Provider Demographics
NPI:1487732533
Name:BESCH, NATHANIEL STUART (DO)
Entity type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:STUART
Last Name:BESCH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WHITEWATER
Mailing Address - State:WI
Mailing Address - Zip Code:53190-1503
Mailing Address - Country:US
Mailing Address - Phone:262-473-4548
Mailing Address - Fax:262-472-7691
Practice Address - Street 1:1305 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WHITEWATER
Practice Address - State:WI
Practice Address - Zip Code:53190-1503
Practice Address - Country:US
Practice Address - Phone:262-473-4548
Practice Address - Fax:262-472-7691
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI48381-021207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1487732533Medicaid
WI1487732533Medicaid
WIK400176899Medicare PIN
WI43523100Medicaid
WIP00439321Medicare PIN
WI011354375Medicare PIN
WI044154340Medicare PIN
WIP00439321Medicare PIN